on safer sex, part two – sexually transmitted infections

If you want medical journal articles and in-depth analysis, I’m gonna suggest heading over to the CDC website or something; my goal in this post is just to give a basic rundown about how to avoid these things, what your responsibilities are, what factors are risky, and just addressing a few general misconceptions I see floating around a lot. This is especially important considering the recent news from the medical community stating that there is now a drug-resistant strain of gonorrhea floating around in the U.S. and elsewhere.

See, I don’t know about anybody else, but in high school the extent of my sex ed class was “sperm meets egg, baby happens, don’t abort it or you’ll regret it forever”. Lots of referring to embryos as Unborn Children, lots of anatomy/physiology, nothing in terms of possible health effects other than “wear a condom”. I was stunned by how little I (and my classmates) knew about anything to do with our sexual health; I mean, I understood that sexually transmitted diseases existed, because my mother was a microbiologist, and I knew there was one called HIV that was really bad and that there were a few others that were really hard to spell, but that was it. I was ignorant, man. My bubble surrounding all that didn’t get burst until I was raped my sophomore year; I then found myself in the local community health clinic with my feet in metal stirrups getting my cervix swabbed. Hearing the nurse spout off all the possible ramifications brought my “don’t get pregnant and everything will be okay” idea to a screeching halt, and I dedicated myself to learning whatever I could find out about STIs and teaching my friends.

It’s funny (in a dark, very non-funny sort of way) the way that we tend to look at STIs. Like rape, we view them as something that “happens to other people”. I always had this weird idea that as long as you weren’t having sex with random heroin users in back alleys, you were pretty much safe. I hear that sentiment echoed by a lot of my peers still, which frankly scares the shit out of me, because we’re grown-ass adults still thinking like high school freshman – and when it comes to your health and the health of others, that’s not really an acceptable thing.

So, allow me to shatter your illusions for a moment.

Hi, I’m Avvie, who goes to a good college in a good part of town, and I have a good friend who recently got herpes from her boyfriend (he never even showed any symptoms).

Hi, I’m Avvie, and my straight-A-student best friend from high school contracted gonorrhea and spread it to her regular partner before she even realized she had it.

Hi, I’m Avvie, and my Ph.D. scientist mother has both strains of HSV (the virus that causes oral/genital herpes).

Hi, I’m Avvie, and one of my coworkers at a high-end downtown clothing store had a high-risk strain of HPV (the virus that can cause cervical cancer and/or genital warts).

Sexually transmitted diseases happen more than we as a society like to admit. A lot more. A hell of a lot more. And they don’t contain themselves in neighborhoods, schools, and age groups that “other people” fit into.

Maybe you think you already know about this stuff. Yeah, yeah, you didn’t doze off in Health class, or your mom is a nurse, or whatever. No, fuck it. Get off your high horse, listen the fuck up. I don’t know you, I don’t care if you want to be a smug know-it-all if it only affects your health. But, newsflash, it doesn’t. It affects a lot of people around you, in a lot of ways.

There’s shit you need to know. You need to care about this. A lot.

And here’s how to go about that.

1. PROTECTING YOURSELF

The best offense is a good defense, or whatever the heck it is they say these days. So when it comes to your sexual partners, realize that you can take nothing for granted.

Sure, maybe your partner shows no visible symptoms of an STD (no weird discharge, bumps, discoloration, whatever). That’s helpful, but Jesus fucking Christ it’s not enough. A ton of STDs can be asymptomatic for weeks, months, years, or even forever. Everything from chlamydia to herpes to HIV can potentially go undetected for more or less a lifetime. This is especially true for men, as women are statistically more likely to show symptoms at some point.

Bottom line: your partner needs to get tested in order for you guys to have safer sex. It’s not an exception, it’s the rule.

Now, I’m going to tell you something that will probably seem really paranoid and off-putting, but bear with me here:

Always, always assume your partner will lie about this.

No. Seriously. I’ve had a partner lie to me about his medical and sexual history before, and it was a fucking awful and traumatic experience. Up til then, I was happy to trust a “sure, of course!” in response to my asking if a partner had been tested recently. Now? No fucking way.

Ask to see documentation of the testing. Don’t fall for any “but they wouldn’t give me any” bullshit; clinics will provide you with written proof of your own test results if you request it. Don’t trust a saved voice mail. Ask to see the results, on paper. If your partner tries to throw a “just trust me” in your face upon this request, I’d highly suggest nixing your plans to be intimate with him or her. Someone willing to dismiss your health concerns for the chance to get into your pants is, generally speaking, not someone you want to be involved with.

Some people think all this can be circumvented by using condoms. The answer is that condoms are very, very helpful in making sex safer. Not only do they offer good contraception, but they protect well (but not 100%) against certain sexually transmitted diseases. Proper condom use should be a part of everyone’s repertoire.

Problem is, condoms don’t protect against certain STDs, and condoms can tear or break, and condoms can leak.

What don’t they protect well against? Herpes and HPV (again, cervical cancer and/or genital warts) are the major culprits. These two STDs are spread through any skin-to-skin contact, rather than bodily fluids, so a condom will do little or nothing to help (little-known fact: it is possible to spread herpes even if the person is not currently having an outbreak).

Condoms also aren’t of much help when it comes to oral sex. A lot of STDs can be transferred through that sort of stuff, though the transmission rate is usually lower than through vaginal/anal sex. You don’t have to swallow semen to be at risk. In fact, oral herpes (also known as cold sores) can be spread to a partner’s genitals and visa versa.

One other important note on self-care: if you’re under the age of 26, do everything you can to get the Gardasil vaccine. Talk to a doctor about it, or read up on it online; it’s the only vaccine I know of that actually helps to prevent any STD. It protects well against two strains of HPV that cause the majority of genital warts cases, and two more that cause a significant number of cervical cancer cases. In my humble opinion they haven’t done nearly enough research on the required follow-ups to the vaccine, but it still could potentially make a huge difference to your own health or the health of future sexual partners. If you can, do it.

2. Protecting Your Partner

Get tested.

No, seriously, get fucking tested.

No, I don’t care if you feel fine and have never had any symptoms. Get tested.

I don’t care if you’ve only had one sexual partner.

Get fucking tested.

I don’t care if you’ve never touched an intravenous drug in your life.

Get. Yourself. Fucking. Tested.

Okay, so, I’m being unfairly harsh. Getting tested is a scary notion for a lot of people, I get that. The idea of potentially finding out that you have an STD is nerve-wracking.

But imagine how much worse you’d feel if you did have something, and unknowingly infected someone else, okay?

Where:

Almost every city I’ve ever been to has had some sort of community clinic that has sliding-scale fees, so cost really should not be an issue. In fact, some places also have centers specifically for cost-free testing. Planned Parenthood is a good place to start looking. Consult Google, Yelp, the Yellow Pages, your school nurse, or a friend or two. I guarantee you, there will be options.

When:

Different STDs can be detected different amounts of time after possible exposure (consult Google for more specific numbers on that), but a general rule is that you need to wait at least a couple weeks after the last time you had sexual contact with someone before you can expect accurate results. For HIV testing specifically, you actually can’t really guarantee accuracy until six months after, though most people will develop detectable antibodies within the first three months or less.

What:

One of the most frustrating things I’ve found in the healthcare system is the fact that, if you just walk in and say “I want to be tested for STIs”, chances are they’ll only test you for one or two things. I once asked for full-spectrum testing, only to be told that I would only be tested for chlamydia and gonorrhea. Um, what?

It definitely helps to discuss your “risk factors” (types of sexual activity you’ve engaged in, any drug use, number of partners, etc) with the doctor if you feel comfortable with it. However, don’t expect that he or she will automatically know all the tests you should get. At one point, a college-health-center nurse tried to talk me out of getting HIV tested after I was raped, because “I was probably fine”. No, guys, the doctor does not always know best.

So, know beforehand what tests you need. If you want to cover your bases, my suggestion is to specifically request to be tested for chlamydia, gonorrhea, HIV, herpes, trichomoniasis and syphilis. In addition, ask for a physical exam to look for any potential symptoms of HPV infection – ladies, sometimes this will just be part of the deal anyway, if you’re getting your annual exam. Guys, you will probably need to specifically request this. Don’t skip this step, even if you’re sure you’re fine, because doctors are trained to look for a lot of things you might never even notice.

Now, if you really want to make sure your bases are covered, consider getting tested for HIV twice (once at three months, once at six), request any available tests for HPV (some places will offer this, some will not), and get tested for any strains of hepatitis that you haven’t been vaccinated against.

Also, specifically for those of us with a vagina: if you have had any discomfort, itching, weird discharge, or anything else, it might be worth asking for a test to detect a potential yeast infection or bacterial vaginosis. Both of these can potentially be transmitted sexually, but can also just sort of happen on their own (I’ve gotten the latter once, in high school) because the PH level of your vagina got thrown out of whack or something. You’ll be prescribed some antibiotics or a cream, it’s really no big deal.

How:

Other than the physical exam (which is pretty much exactly what it sounds like), you’ll probably need a swab (of mucus, discharges, cervical cells, whatever), a urine test, and possibly a blood test. Important note: you can be tested for HIV even without a blood test! Many clinics carry HIV tests that you use just by swabbing a little paper tab over your gums, so fear of needles is absolutely no excuse for skipping that test!

I should note that none of this should hurt. In my experience, reproductive health clinic nurses are some of the frickin best phlebotomists in the world – I used to be afraid of needles, but honestly they never even so much as left as bruise when I got tested. Plus, they don’t actually need that much blood to test for most STDs, so it’s not nearly as bad as getting blood tests for most other things.

Generally, results take three to five days to come back from the lab, and the clinic will contact you with them as soon as they can.

Again, this will sound vaguely crazy, but try not to be too embarrassed or shy. These people do this stuff for a living, and I guarantee you are definitely not the strangest case they’ve seen in their careers – hell, you’re probably not even the strangest case they’ve seen in any given day. Their job really is just to help you stay healthier, and keep the rest of the world a little healthier, too.

Now, here’s the tough question. What do you do if a test comes back positive?

1. Try not to freak out. I know it’s tempting, but give it your best shot. STDs are not uncommon, and you’re not some sort of subhuman for having one. Hell, over 50% of people will contract one at some point.

2. Find out what your options are. Some STIs can be cured with something as simple as an injection of antibiotics or some pills to pick up at the pharmacy. Even for chronic infections, there are medications that can help symptoms and lower the frequency of outbreaks or complications. Generally speaking, the sooner you start on a treatment plan, the more effective it will be. Ask your doctor to discuss some possible steps you can take, join a support group, do some research – whatever it takes to make you feel like you’re making positive steps toward dealing with it.

3. Inform your partners.

This is absolutely the most important thing. Before you have sexual contact with anyone (this includes kissing, in many cases), you need to let them know about any potential health risks. Will this lose you some opportunities for sex? Yes, probably. I won’t lie about that. But it will also make you the much bigger person in the situation, which is a hell of a lot more important.

Let me reiterate this.

There is no excuse for failing to clearly and accurately inform your partner of any potentially sexually transmitted infections or diseases you may be carrying.

Now, let’s say you at one point contracted chlamydia, faithfully took the antibiotics, and got re-tested to ensure that the infection had been cleared. A year down the road, do you really need to tell a partner about that? I’ll leave that one up to you. But if there’s any chance whatsoever that you might still have the infection, it’s your responsibility to tell them. I don’t like to “should” on people, but this is one situation where I’m going to take a lot of liberties with that.

Another note: you need to inform future partners, but you also need to inform any past partners who may have a) given you the STD, or b) been exposed to it. If you test positive for any STD and have had any sexual/intimate contact with anyone since the last time you were tested (or even just within the last year, as a rule of thumb), you need to let them know, so that they can get tested and ensure that they’re not passing on anything to their current or future partners. It’s tough to do, but it really is non-negotiable. It needs to happen. You’re not allowed to rely on their spontaneously deciding to get tested before they have another partner.

We care about safer sex, right? We’re a generation that faces a world where diseases can spread quickly and easily, and people start having sex fairly early. As such, we need to make conscientiousness about sexual health the rule, rather than the exception. It’s all about respecting yourself and your partners; and if it catches on, we’d be a heck of a better society for it.

I’m not trying to scare or guilt anybody.

I’m just trying to fill in the miscellaneous (and majorly important) gaps our educational system has left behind.